Central autonomic nervous system response to autonomic challenges is altered in patients with a previous episode of Takotsubo cardiomyopathy

Abstract

The central autonomic response to autonomic challenges is altered in patients with Takotsubo cardiomyopathy, thus suggesting a dysregulation of the central autonomic nervous system network. Subsequent studies are needed to unveil whether these alterations are causal or predisposing factors to Takotsubo cardiomyopathy.

Takotsubo Syndrome – Predictable from brain imaging data

“…In fact, patients afflicted with depression and/or anxiety demonstrate functional and structural adaptations in most of the brain regions, which we found to be predictive for the presence of TTS. In this context, a core area of the identified TTS-specific network, the amygdala, is known to be strongly involved in cardiac control and also plays a pivotal role in fear conditioning 9 , mental 3 and posttraumatic stress 10 , depression 11 as well as anxiety disorders 12 . However, since the examined TTS patients in the present study did not show differences in anxiety, depression, or stress symptoms compared to the controls, our results do not seem to be driven by the presence of possible psychiatric disorders.…”

“…This raises the question whether brain alterations involved in the pathophysiology of TTS are only present during the acute phase, or perhaps pre- or post-existent. In this context, literature suggests that a history of neurological and psychiatric disorders might induce functional and structural changes within the brain leading to sympathetic hyperactivation, excessive catecholamine release and subsequently TTS 3, 4, 16 . Therefore, pre-existing alterations of the respective brain areas might serve as a potential risk factor for TTS.…”

“…Given that external stressors are a unique feature that provoke a TTS event, it is conceivable that TTS is triggered by neuronal alterations in the limbic system, presuming an emotional hypersensitivity or disturbed emotional processing in these patients. In fact, first studies provide insights into neuronal alterations in brain regions constituting the limbic and the central autonomic nervous system 3, 4 . Research in the field of neuroimaging and TTS is rather sparse and limited to studies applying hypotheses-driven mass-univariate statistics 3, 4 .…”

“…In fact, first studies provide insights into neuronal alterations in brain regions constituting the limbic and the central autonomic nervous system 3, 4 . Research in the field of neuroimaging and TTS is rather sparse and limited to studies applying hypotheses-driven mass-univariate statistics 3, 4 . However, with this statistical approach it is not possible to draw conclusions about whether patients with TTS show homogeneous neural alterations, i.e.…”

The Sympathetic Nervous System in the Pathogenesis of Takotsubo Syndrome

“…95 The central autonomic response to autonomic challenges, such as Valsalva and cold exposure, is also altered in individuals with a remote history of TS as assessed by functional MRI. 96 These studies suggest that individuals with a history of TS may have chronic sympathetic/parasympathetic imbalance, thus, rendering them particularly vulnerable to acute sympathetic stimulation.…”